tbuckley/cabot-search huggingface dataset:
Abstract 10535: Relation of Multiple Low-Risk Lifestyle Behaviors With Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies
Authors: Victoria Chen, Tauseef A Khan, Suleman Ahmad, Danielle Lee, Lily Wang, Charlotte Gallienne, Sonia Blanco Mejia, David Field, Paul Poirier, David C Lau, Lawrence A Leiter, Cyril Kendall, John L Sievenpiper
Journal: Circulation (2022)

Introduction: The association of combined low-risk lifestyle behaviors (LRLBs) with cardiovascular disease (CVD) and all-cause mortality has not been systematically quantified. Objective: We undertook a systematic review and dose-response meta-analysis to assess the association of combined LRLBs with CVD and all-cause mortality. Methods: MEDLINE, EMBASE and Cochrane were searched up to December 29, 2021. Prospective cohort studies reporting the association between a minimum of 3 combined LRLBs (including healthy diet) with CVD, coronary heart disease (CHD) and stroke incidence and mortality were included. Independent reviewers extracted data and assessed study quality. Highest vs. lowest LRLB score was pooled using random effects. Heterogeneity was assessed (Cochran Q) and quantified (I 2 ). Global dose response meta-analysis (DRM) for maximum adherence was estimated using one-stage linear mixed model. The certainty of the evidence was assessed using GRADE. Results: 116 cohort comparisons (n=9,775,191) involving 382,922 cases were included. Comparing highest with lowest adherence LRLBs were associated with lower risk of CHD incidence (RR, 0.29 [95% CI, 0.21, 0.42]), stroke incidence (0.56 [0.50, 0.62]), CVD incidence (0.47 [0.37, 0.58]), CHD mortality (0.32 [0.25, 0.41]), stroke mortality (0.37 [0.30, 0.46]), CVD mortality (0.41 [0.34, 0.49]) and all-cause mortality (0.46 [0.41 to 0.52]). DRM analysis showed a linear association between LRLBs and all outcomes reaching a global DRM between 59-76% protection. LRLBs were defined with variable ranges as a healthy body weight (body mass index &lt;30kg/m 2 ), healthy diet (healthy diet score &gt;median), regular physical activity (1/week to &gt;30 minutes/day), smoking cessation (never smoked or smoking cessation), light alcohol intake (≤30g/day) and adequate sleep (5.5-9 hours). The certainty of the evidence was graded as moderate to high owing to downgrades for inconsistency and/or upgrades for a large magnitude of effect and significant dose-response gradient. Conclusions: Pooled analyses show that the combination of LRLBs was associated with a substantial lower risk of CVD outcomes and all-cause mortality. The available evidence provides a very good indication of the benefit of combined LRLBs.
Abstract 10949: Standard Modifiable Cardiovascular Risk Factors and Long-Term Clinical Outcomes Among Patients With ST-Elevation Myocardial Infarction
Authors: Yu Suresvar Singh, Hideki Wada, Manabu Ogita, Yutaka Nakamura, Moriya Sohshi, Goh Ishikawa, Kentaro Yasuda, Jun Shitara, Satoru SUWA, Katsumi MIYAUCHI, Tohru Minamino
Journal: Circulation (2022)

Background: Little is known about the association between standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes, dyslipidemia, and smoking) and clinical outcomes among patients with STEMI. Methods and Results: STEMI patients who underwent primary PCI were enrolled. Primary endpoint was all-cause death. Between 1999 and 2015, 126 (6.4%) of 1,963 patients with STEMI had no SMuRFs. Patients without SMuRF were significantly older and more likely to be female. During median follow-up period of 4.8 years, cumulative incidences of death were significantly higher in patients without SMuRF (log-rank p&lt;0.0001). Multivariate Cox hazard analysis showed that patients without SMuRF had significantly higher risk of mortality (HR 1.41, 95%CI 1.07-1.86, p=0.01). Conclusions: STEMI patients who didn’t have SMuRFs had worse clinical outcomes compared with those with at least one SMuRFs.
Abstract 10533: Cardiorenal Effects of Sglt2 Inhibitors and Finerenone in Type 2 Diabetes and Chronic Kidney Disease. Single, Dual or Triple Therapy? A Network Meta-Analysis
Authors: Jesus Diaz Acevedo, Greilys Lazcano, Mariana Soto, Adela Castro, Carlos Penaherrera, Andres F Buitrago, NAVEEN PUNCHAYIL NARAYANANKUTTY, Viviana Navas, Jesus E Pino
Journal: Circulation (2022)

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and a non-steroidal mineralocorticoid receptor antagonist, finerenone, have demonstrated their efficacy in slowing CKD progression and preventing cardiovascular events in diabetic kidney disease (DKD). However, it is unclear which one is more effective or whether a combination could provide additional benefits. Methods: A network meta-analysis (NMA) was conducted on RCTs of DKD, which evaluated the cardiovascular and renal effects of SGLT2i and finerenone. The primary outcome was a cardiorenal outcome composed of GFR decline as defined in original RCTs, end-stage kidney disease (ESKD), heart failure hospitalization (HHF), and death from renal and cardiovascular causes. Results: This NMA comprised 4 RCTs and 61,609 patient-year with DKD. Dual therapy with SGLT2i+RAASi or finerenone+RAASi was more effective than single therapy with RAAS inhibition (RAASi) for the risk reduction of the cardiorenal composite HR 0.67 (95% CrI 0.60 - 0.74) and 0.81 (95% CrI 0.75 - 0.89), respectively. The dual therapy with SGLT2i+RAASi was superior to finerenone+RAASi HR 0.82 (95% CrI 0.72 - 0.94) for the reduction of cardiorenal events (Table 1). The triple therapy (SGLT2i+finerenone+RAASi) vs RAASi showed a 46% relative risk reduction (HR 0.54 95% CrI 0.5 - 0.58) for the cardiorenal composite. Finerenone+RAASi was most likely to lead to discontinuation of therapy due to hyperkalemia HR 2.83 (95% CrI 1.96 - 4.08) when compared to RAASi, however, it was not notice when compared to triple therapy HR 2.83 (95% CrI 0.83 - 9.62). All therapies reduced the risk of all-cause death as follows finerenone+RAASi (HR 0.88, 95% CrI 0.80 - 0.98), SGLT2i+RAASi HR 0.78 (95% CrI 0.66 - 0.91) and SGLT2i+finerenone+RAASi HR 0.69 (95% CrI 0.63 - 0.75). Conclusion: This NMA suggests that triple therapy with SGLT2i+finerenone+RAASi is superior in reducing cardiorenal events compared to single or dual therapy with a similar safety profile.
Abstract 10334: Vital Exhaustion and Cardiac Biomarkers - The Atherosclerosis Risk in Communities Study
Authors: Matthew R Deshotels, Mahmoud Al Rifai, Ali Agha, Caroline Sun, Elizabeth Selvin, B Gwen Windham, Viola Vaccarino, Erin D Michos, Hani Jneid, Glenn N Levine, Salim S Virani, Christie M Ballantyne, VIJAY NAMBI
Journal: Circulation (2022)

Introduction: Vital exhaustion (VE), defined as excessive fatigue and demoralization due to chronic stress, is a risk factor for cardiovascular disease (CVD), but the mechanism is unclear. We examined the association of VE with biomarkers of cardiac injury, neurohormonal stress and inflammation in the Atherosclerosis Risk in Communities (ARIC) study. Methods: Symptoms of VE were measured at ARIC visit 2 (1990-92, n= 11,588, mean age 57) using the Maastricht Vital Exhaustion Questionnaire (MVEQ). We analyzed the association of VE with cardiac biomarkers [High-sensitivity troponin T (Hs-TnT), N-terminal pro brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (Hs-CRP)] levels in adults without known CVD. Symptoms of VE (MVEQ scores) were categorized into quartiles. Elevated biomarker levels were defined as Hs-TnT ≥ 13 ng/L, NT-proBNP ≥ 125 pg/mL, and hs-CRP ≥ 2 mg/L. Logistic regression models adjusted for demographics and comorbidities were used to test for associations. The associations of VE (MVEQ score ≥16), elevated biomarkers, or both with incident CVD events after 6-year follow up was assessed by Cox proportional hazard regression. Results: Compared with the lowest quartile of VE (MVEQ ≤ 4), the highest quartile of VE (MVEQ 16-42), in adjusted models, was associated with elevated Hs-TnT, NT-proBNP, and hs-CRP [Odds Ratio (95% confidence interval) of 1.75 (1.34-2.29, p&lt;0.01), 1.40 (1.19-1.64, p&lt;0.01), and 1.14 (1.01-1.28, p&lt;0.01), respectively]. The highest quartile of VE was associated with increased risk of CVD events. The risk was increased further in the setting of both significant VE (MVEQ ≥16) and elevated biomarkers (Table). Conclusions: Symptoms of VE are associated with elevated Hs-TnT, NT-proBNP, and Hs-CRP independent of traditional CVD risk factors. The presence of VE and elevated cardiac biomarkers is associated with high risk of incident CVD events in adults without CVD.
Abstract 10748: Development and Internal Validation of the Coronary Revascularization-Tool for Evidence-Based Individualized Share Decision-Making (CR-DECIDE) Major Adverse Cardiovascular Events Model
Authors: Ricky D Turgeon, May Lee, Colleen M Norris, John Spertus, Karin Humphries
Journal: Circulation (2022)

Introduction: Coronary revascularization guidelines emphasize shared decision-making (SDM) for chronic CAD management. Decision aids that provide individualized estimates of benefits &amp; risks could improve the relevance &amp; evidence base of SDM. This study sought to develop &amp; internally validate a clinical prediction model for 3-year MACE (death/MI/stroke) in patients with chronic CAD for integration into a point-of-care decision aid. Methods: We used the prospective Cardiac Services British Columbia Registry to assemble a cohort of adults with stable angina &amp; obstructive CAD who underwent first diagnostic coronary angiography between 2004-2015, excluding left main disease, LVEF &lt;30%, prior MI/PCI/CABG, NYHA 3-4, &amp; CCS class 4 angina for model derivation. Internal validation was performed with 200 bootstrap samples &amp; missing data was handled by multiple imputation. We included 22 candidate variables with 1 interaction term, based on prior literature, in a Cox proportional-hazards model. We assessed model discrimination &amp; calibration using Harrell’s c-index &amp; the calibration slope, respectively. Results: We included 24,990 participants (2026 events). We kept 22 predictors in the final model; the interaction term was removed since it was not significant (p=0.46). Due to non-proportionality, pLAD stenosis &amp; angiographer’s recommended treatment were used as stratification variables (6 strata). Optimism-corrected c-index was 0.69 &amp; calibration slope was 0.97. Conclusions: The CR-DECIDE model had moderate ability to predict MACE in patients with chronic CAD, &amp; warrants further validation in an external dataset &amp; impact analysis as part of a point-of-care decision aid.
Abstract 10580: Machine Learning-Assisted Echocardiographic Identification of Children at High Risk for Treatment-Related Cardiomyopathy: A Proof-of-Concept Study
Authors: Christina Yang, Zih-Hua Chen, Lahari Gorantla, Sanika A Joshi, Nicolas J Longhi, Jamie Yang, Saro Armenian, Aarti Bhat, William Border, Sujatha Buddhe, Kasey J Leger, Wendy M Leisenring, Lillian R Meacham, Paul Nathan, Ritu Sachdeva, Karim Sadak, Eric Chow, Patrick M Boyle, Lindsay A Edwards
Journal: Circulation (2022)

Introduction: Childhood cancer survivors require life-long surveillance for treatment-related cardiomyopathy/heart failure (CHF). Ultimately, we aim to use machine learning to aid in echocardiographic discrimination of survivors more likely to develop future CHF. For this feasibility pilot, we built two proof-of-concept deep convolutional neural networks (DCNNs) tasked with binary classification of present/future CHF versus no CHF with the aim of assessing optimal data input format and model architecture. Methods: From a robust multi-institutional surveillance echo dataset, we selected pilot data comprising 171 parasternal short axis echo clips, 52 from 5 CHF+ (present and future CHF) and 119 from 21 CHF- patients. We built two DCNN models differing in frame selection for input data (Fig. 1), both tasked with binary classification of CHF+ vs. CHF-. We used holdout subsets in a 10-fold cross-validation framework to test model performance and Student’s t test (paired) to compare model performance. Results: Classification performance was similar, with mean AUROC values of 0.59 ± 0.09 and 0.53 ± 0.11 (p=0.14) for the models trained on Type I and Type II montages, respectively (Fig. 2). Conclusions: The DCNN framework is feasible for a model tasked with classifying CHF status, and we are optimistic that a similar model can be trained with pre-CHF diagnosis (case) vs control patient images to facilitate machine learning-assisted identification of childhood cancer survivors more likely to develop CHF in the future.
Abstract 10844: Black Race and Risk of Bleeding Events in Patients With Durable Left Ventricular Assist Devices
Authors: Nirupama S Vellanki, kevin kennedy, Shweta R Motiwala, Arthur Reshad Garan, E. Wilson Grandin, Pablo A Quintero, lisa fleming, Roy Sriwattanakomen, Jennifer E Ho, Marwa Sabe
Journal: Circulation (2022)

Introduction: An analysis from the MOMENTUM 3 trial showed that black patients have an increased risk of bleeding compared to white patients. We sought to examine racial differences in the risk of long term bleeding (up to 3 years) in patients with cf-LVADs using the INTERMACS database. Hypothesis: Black race is associated with an increased risk of bleeding events after cf-LVAD. Methods: We included 11,457 patients from the INTERMACS registry, who were implanted with primary CF-LVAD between 2012-2017. Using a cox proportional hazards model, we assessed the relationship between race and bleeding events up to 3 years post LVAD implantation after adjusting for covariates*. Analysis was started at 3 months post implantation to focus on long-term bleeding risk rather than early, post-operative bleeding. These bleeding events were stratified for the two major types of bleeding, GI bleeding (GIB) and intracranial hemorrhage (ICH). Results: This study included 2884 black patients (25.8%) and 8505 non-black patients (74.2%). Black patients tended to be younger (52.2 vs 58.6 yr p&lt;0.001) with more women (30.9% vs 17.7% p&lt;0.001) when compared to non-black patients. There were 1442 black patients who had a bleeding event vs 3972 non-black patients (50.0% vs 46.7% p=0.007) over 3 years of follow up (Fig 1). After adjusting for age, sex, and other covariates*, we found that black patients were more likely to have any bleeding event post LVAD implantation compared to non-black patients (adj HR 1.19 p&lt;0.0001). When stratified by type of bleeding, the risk of ICH was similar between the two groups (10.8% vs 9.2%, adj HR 1.12, p 0.35), but the risk of GIB was higher among black vs non-black patients (30.9% vs 29.6%; adj HR 1.36, p&lt;0.0001). Conclusions: Black patients have a higher risk of long term bleeding and specifically GIB after LVAD implantation. Further studies are warranted to elucidate this relationship and potential clinical implications including anticoagulation strategies.
Abstract 10305: A Bioresorbable Pacemaker With Transient Closed-Loop System
Authors: Yeonsik Choi, Rose Yin, Anna Pfenniger, Rishi Arora, Igor Efimov, John A Rogers
Journal: Circulation (2022)

Introduction: Conventional temporary pacemakers with percutaneous pacing leads limit patient mobility, create risks for infections, require removal procedures following completion of therapy and demand an additional collection of wired devices to monitor the status of the patient and to provide closed-loop operation. Recently reported wireless, bioresorbable pacemakers avoid the first set of disadvantages, but they must still be paired with conventional wired-based systems for cardiac monitoring, power delivery and control. Methods: We present a bioresorbable pacemaker that combines with a wirelessly networked collection of temporary, body-integrated devices to (1) power, control, and monitor processes of cardiac stimulation, (2) track cardiopulmonary status via comprehensive, multi-modal measurements, (3) provide patient-specific multi-haptic feedback on device and physiological status, and (4) support transient operation through bioresorption and gentle removal from the skin. Results: Data captured from various locations of the body yield detailed information of patient status, across various aspects of cardiopulmonary health and physical activity. The results define autonomous rate-adaptive pacing parameters to match metabolic demand via wireless powering of the bioresorbable module. Operation is possible over extended periods to match clinical needs, enabled by advanced mechanical designs and drug eluting configurations of the battery-free, bioresorbable pacemaker platform. Replacement of the cardiac module can occur in a manner that does not disrupt continuous pacing. The skin-interfaced devices can be easily peeled away for removal after patient recovery, due to their soft, flexible construction. Conclusions: We demonstrate for the first time that a bioresorbable pacemaker with transient closed-loop system is feasible in a clinically relevant, large animal and human whole heart model. Further improvements in this technology could open doors for out of hospital temporary pacing for varying periods of time, without the need for permanent hardware.
Abstract 10271: Poor Response and Nonresponse to Clinically Available Supervised Exercise Therapy for Peripheral Artery Disease: A Pooled Analysis
Authors: Mary O Whipple, Dereck Salisbury, Rebecca J Brown, Diane J Treat-Jacobson
Journal: Circulation (2022)

Introduction: Nonresponse to supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) is a known, but poorly understood, phenomenon affecting approximately one third of individuals. This study evaluated the prevalence and characteristics of poor response and nonresponse among patients with PAD participating in clinically-available SET programs. Methods: Data were pooled from four studies (conducted from 2015-2021) embedded within clinically-available SET programs in the Midwest. SET was 12 weeks in duration and included individualized treadmill walking or other exercise modalities (e.g., total body recumbent stepping, cycling) to moderate ischemia, according to patient ability. In addition to providing demographic and medical information, patients completed the 6-minute walk test (6MWT), Short Physical Performance Battery (SPPB), Walking Impairment Questionnaire (WIQ), and PAD Quality of Life Questionnaire (PADQOL) at baseline and 12 weeks. In post-hoc analyses, we examined the prevalence of nonresponse (including no change [≤0 m] or lack of a clinically meaningful change [≤9 m]) in the 6MWT total distance (primary outcome) and other objective and patient-reported outcomes. Results: A total of 130 patients (85%) completed SET. Mean (SD) age was 72.3 (8.4), BMI 30.2 (6.3), ABI 0.68 (0.23) and 53.1% of patients were male. Despite the overall improvement observed in 6MWT total distance (34.1 [57.1] meters), there was substantial inter-individual variability in changes in 6MWT total distance over 12 weeks, ranging from a 249.9-meter increase to a 104.6-meter decrease. The prevalence of nonresponse (no change/decline in performance) in 6MWT total distance was 24.6%. The prevalence of poor response (lack of a clinically meaningful improvement) was 32.3%. Similar patterns of poor and nonresponse were observed in both objective and patient-reported measures of physical function. Conclusions: The prevalence of nonresponse observed in these clinically available programs is similar to what has been reported in randomized controlled trials. Additional research should examine modifiable predictors of poor and nonresponse to inform programming and maximize an individual’s potential benefit from exercise therapy.
Abstract 10907: Woven Coronary Artery: A River With Many Currents
Authors: Alexander E Sullivan, Tara Holder, Jared M O'Leary
Journal: Circulation (2022)

Introduction: Congenital coronary artery anomalies can increase the risk of cardiovascular events and sudden death. A woven coronary artery is a rare abnormality with multiple lumens in a single vessel, giving the appearance of complex coronary plaque or a dissection flap on coronary angiography. Clinical Case: A 57-year-old man with group IV pulmonary hypertension and chronic right-sided heart failure presented for consideration of pulmonary endarterectomy. He underwent preoperative coronary angiography which demonstrated nonobstructive disease within the left anterior descending and circumflex arteries and a complex lesion in the right coronary artery (RCA- Figure 1). The lesion was further evaluated using intravascular ultrasound (IVUS) which demonstrated numerous, complex, communicating lumens and fenestrations within a single external elastic lamina suggestive of a woven coronary artery anomaly (Figure 2). This was recognized as a benign abnormality for which the patient was managed medically, and he underwent a successful pulmonary endarterectomy several days later. Discussion: Woven coronary arteries are rare and complex lesions made up of numerous lumens often found in the proximal to mid-RCA. These lesions typically permit normal blood flow and are found incidentally in asymptomatic patients. Woven coronary arteries can be mistaken for complex lesions, dissection, or recanalized thrombus, leading to unnecessary and potentially dangerous percutaneous coronary intervention. Woven arteries should not be treated with angioplasty in the absence of thrombotic occlusion as this can lead to arterial vessel damage. Intracoronary imaging, including IVUS, is vital to differentiate woven coronary arteries from other coronary pathologies. Conclusion: Woven coronary arteries may mimic dissection or recanalized thrombus, but can be promptly recognized as a benign congenital anomaly with intracoronary imaging modalities such as IVUS.